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Autism:DiagnosisandInterventionStrategiesDr Saima Hussain Ijaz MD, MA – ABABehaviour Consultant – Intensive
SolutionsBritish Columbia - Canadawww.autismsolutions.info
Autism …Too Complexto Understand?Word Autism was hardly mentioned in the Medical Text in the 80’s and 90’s
Stunning Statistics with an annual rise of 16% Diagnosis keeps Evolving Under Diagnosed to Over Diagnosed Movies like Rain Man and Extraordinary Geniuse slike Einstein & Bill Gates IQ ranging from extreme retardation to over 150 People have made instant millions, by selling a “cure” for autism Unfortunately there is No Cure–Life Long Condition Some individuals with autism have very HI GHIQ –PhDs No SINGLE MAGIC BULLET for sudden improvement–Multiple Therapies No two cases are the same and neither is the advice of any two professionals No clinical test to confirm the Diagnosis Fewer Resources and Professionals and increasing number of cases
Tussle amongst Psychiatrists and Paediatricians as the primary specialist
My Personalanda ProfessionalAttempt:To Empowerthe ParentsBySimplifyingAutismDisorderandtheTherapies
As doctors and therapists, we owe it to our profession and the community we serve to keep ourselves up to date, whether it falls in our jurisdiction or not .
You can encounter an ASD as your patient, so knowing how to communicate and what to expect could be helpful.
Autism is not all that tough to understand if you really get the basics.
On a personal level, with this high an incidence, it can affect someone near and dear to each one of us
Early Diagnosis and Intervention can make a Huge Difference on the child’s prognosis.
You be helping not just a child, but a whole family.
Staggering rise over the last50 Years
UsualPresentingComplaints No attention span with or without Hyperactivity Impulsive or dangerous behaviour Screams and cries without apparent reasons Aggression or Self Injury Tendencies Inability to relate to adults or kids Lack of speech Inappropriate toy play Difficulty dealing with changes No sense of danger Strange attachment to objects Lack of eye contact
Very Important to checktheSocio–CommunicativeAspect
Responded to name by 12 months of agePoints to show something or waves back Avoids eye-contact Prefers to play aloneOnly interacts to achieve a desired Has MOSTLY flat facial expressions
Was babbling or saying a few words and then lost it
AvoidsorresistsphysicalcontactIsnotcomfortedbyothersduringdistress
Unusualreactionstothewaythingssound,look,orfeel
Se
tanAPPOINTMENTof40minutestoanHourSo
meBasicToyslikeBubbles or Abacus
Askabout:
• Onset,suddenversusgradual• HistoryofMultipleEarInfections,EarDrainage• Recentenvironmental,socialoremotionalchanges.
• Who is the Primary Caregiver andhow much timeshe’sspendingwiththe child• Child’sappetite,sleep and activitylevel
Evaluateforthedevelopmentaldelays.
• Observethe way childexploreshis environmentvisuallyandphysically• Hows/he responds to yourwordsandgestures.
• Hows/hereachesoutforanobjectofinterest.
DSM–VCurrently
,orbyhistory,mustmeetcriteriaA,B,C,andD
A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communicative behaviors used for social interaction
3. Deficits in developing and maintaining relationships
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following
1. Stereotyped or repetitive speech, motor movements, or use of objects
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment;
DSM–VCurrently,orbyhistory,mustmeetcriteriaA,B,C,andD
C.Symptomsmustbepresentinearlychildhood.
D.Symptomstogetherlimitandimpaireverydayfunctioning.
SingleSpectrumbutSignificantIndividualVariability
Severity ofASD Symptoms:
AutismNonverbalwithodd/severebehavioursPDD-NOSNonverbalwithmildoddbehaviourAspergerVerbalwithodd/severbehaviours
ThreeTypes
WhattoTelltheParentandHowIfnot sure,than don’t label-Your words willbechangingthe lifeofthis family
• Do you need More timetoObserveand Evaluate?
AnotherAppointment/Referral isbetterthanahasty Diagnosis.
Referralto:• Pediatrician– 2ndopinion• ENTorAudiologist• Speech LanguagePathologist• Psychologist• OccupationalTherapist
NoRoleofMedicinesinLittleKidsUnlessanEpileptic
ParentalAdviceregardingcommunicationwiththechild
PickoneLanguageforCommunication.English!UseLesswords,pleasant-neutraltone.LotsofSmilesGesturesandVisualCuesFirmpressureontheshouldersIntroducingVisualCommunicationSystemPraiseorgestureforcooperation
Handfistbump/thumbsup
GeneralRecommendations:LifeStyle
Nutrition
4-5small meal Fingerfoods Bakedandgrilled vsfried Cutup vegesassnacks Stretchingwithchoices Drycerealandraisinsassnack Whitemeat,fish Milk and juicevspop Nuts
Supplements
Levelof Activity
Regularstructuredactivities,likerunning,walking.
Climbing and jumping Teachingtoridetricycle Bikewithtrainingwheels Stepsand balancebeams Walking paths Pool
AdviseforPromotingSocialand
EmotionalGrowt
hPreventingandAddressingChallengingBeh
aviours
• TurnTakingSiblingPlayRoutines• CauseandAffectToys• Building onnonverbal/visualcommunication• UseofLabelledPictures• RelaxationTechniquesfor BOTH• IntroducingComputerorI-Padtime• Relaxingbubblebathbeforebedtime
• PsychologicalandSLPAssessmentandaProgramPlan• OccupationalTherapistforSensoryIntegration
• Mention:
20hr/weekoneononeinterventioncanhavegreatlearningoutcomesandbetterprognosis.
Pictureof anAutistic Child
Tantrum vs Meltdown
Reasons ofMeltdowns
SensoryOverload:Analyze theDeterrents
Ifsuddenonset,thenruleoutsicknessandpain
InabilitytoCommunicateNeeds
Overwhelming Expectations
HowtocalmdownthisKid
WhyThese Sensory Issues
Motivators andDeterrents
# Motivators Effectivesince
# Deterrents Howsevere
MRI and PET Scan Studies
indicate thatthebrainsofchildrenwith autismaredifferent
Unusualbraingrowthfrom6-14months:morebutsmallercells
Frontallobe(visualmemory&planning) Temporallobe(soundandnoise) Amygdala(emotions) Hippocampus(learning&memory)
FunctionalMRI ScanStudies Indicate
Underconnectivityof theAutistic Brain
CommonCo-occurringMedicalConditions
• Oesophagitis• Gastritis• Reflux• Asthma• Eczema• Allergies• Earinfections• Respiratoryinfections• Migraineheadaches• FoodintolerancescausingGIsymptoms
Noncommunicatingkidspainsigns
Suddenchangeinbehaviour Lossofappetite,gagging,throwingup Difficultyfallingasleep Aggression Coveringears Selfinjuriousbehaviour Irritability orextrememoodiness Differentbodyposturing Moaning,whimpering,crying. Meltdowns
PsychiatricDiagnosis inSchoolAge Children withASD
PsychiatricDiagnosis SchoolAge ChildrenwithASD
Anxiety 25%
Depression 6%
OCD 10 %
Psychosis 1%
Other 14%
PresentationofPsychiatricSymptoms
–Thepresentationofpsychiatricsymptomsisinfluencedbytheunderlyingdevelopmentaldisorderanditisoftenquitedifferentfromtheoneofthegeneralpopulation.
Considerinabilitytocommunicationangerorsadness. Considerhighlevelofstrangeranxiety. Considerdifficultythepersonisexperiencinginanunfamiliarplace. ConsiderflatexpressionsandoddbehaviourspresentinASDpopulation. Considerunderlyingmedicalproblem. Considerrecent changesin child’scaregiverstatus orhis environment.
Historyo
frecentchangeinsleep,appetiteandinterestsalongwithmoodchanges.H/O
PsychologicalorSLPAssessmentandCommunicationBuilding PlanH/O OccupationalTherapistInputRegardingSensoryDiet
PsychiatricMeds
SRRI/SNRI- MidTeens
Prozac Effexor
Avoid Atypical
Seroquel Risperdal
Variable RelaxationTechniques
SoothingSounds&
Colours
Rocking and Swinging
MajorityisSoundSensitive
• Noisecanbemagnifiedandsoundsbecomedistortedandmuddled.• Maybeabletohearconversationsandothersoundsinthedistance.• Inabilitytocutoutsounds–
notablybackgroundnoise,leadingtodifficultiesconcentrating.• Maynotacknowledgetalking• May onlyhearsoundsin oneear,theotherear
havingonlypartialhearingornoneatall.
• May notacknowledgeany sounds.
• Anaudiologistcanhelpruleoutdeafness.
Youcouldhelpby:
• Shuttingdoorsandwindowstoreduceexternalsounds• ListeningtopleasantsoundsandstepsforSoundIntegration.• Providingearplugsandmusictolistentowhenfeelingoverwhelmed• Creatingascreenedworkstationinth
eclassroom,positioningthepersonawayfromdoorsandwindows.• Usingshortsentencesorphrasesandlow
toneswhileaddressingthechild• Usingavisualwayofcommunication,likegesturesandPECs
AvoidanceofeyecontactisONLYoneofthecommonvisual behaviours
flickinghandstowatchthem
Positioningfingersinfrontof eyes͞tocropthevisualfield͟.
lookingatsomething,thenlookingawaybeforepickingitup
peeringoutofthesidesoftheeyes
usingperipheralratherthancentralvisionformanyactivities
child'sspinningandrunningaroundincirclestovisualizeobjectsfromallangles
Basicinterventionstoimprovecentralandambientvision
Lightsandmotion,likeusinglavalampforrelaxation.
Usingflashlighttolabeleverydaythinginadarkroomcanhelpfocusalongwithbuildingearlyvocabulary.
Activitieswhilelookingintoamirror,likepointingandnamingself.Teachingchild topointandlabelbodypartsandemotions.
Blowingbubblesforcatchingandpopping.
Over-Sensitive toLightTouch
• Touchcanbepainfulanduncomfortable-peoplemaynotliketobetouched.
• Dislikes havinganythingonhandsorfeet.• Difficultiesbrushingandwashinghairbecauseheadissensitive.• Mayfindmanyfoodtexturesuncomfortable.• Onlytoleratescertaintypesofclothingortextures.
Youcouldhelpby:
• Warningthepersonifyouareabouttotouchthem-alwaysapproachthemfromthefront
• Changingthetextureoffood• Slowlyintroducin
gdifferenttexturesaroundtheperson'smouth,suchasaflannel,atoothbrush.
• Graduallyintroducingdifferenttexturestotouch,eghaveaboxofmaterialsavailable
• Turningclothesinsideoutsothereisnoseam,removinganytagsorlabels• Allowingthepersontowearclothesthey'recomfortablein.• Prewashingnewclothestotakeoutthecrispinesshelps• Handmedownsareappreciated
OtherRelaxing/StimulatingandTeachingSenses
Deeppressure
Vestibular-movement,balanceandemotionalregulation.
Proprioceptive-bodypositioninrelativetobodyparts
Kinesthetic-bodyandmusclepositioningduringmotion
KinestheticLearning
HelpfulStrategies:
Double,tightvestunderneathalltheclothingprovidesdeeppressureandasmoothprotectivelayeringforotherclothes.
Usingweightedblanketsorsleepingbags
Usingrocking,swingingorspinningtogetsomesensoryinput.
Positioningfurniturearoundtheedgeofaroomtomakenavigationeasier
Puttingcolouredtapeorsteppingmatsonthefloortoindicatepathsandboundaries
Usingthe'arm's-lengthrule'tojudgepersonalspace-thismeansstandinganarm'slengthawayfromotherpeople.
Help this Child Play and Relax
Turntakingplaywithenjoyabletoys
Learning,exercise, stimulationandentertainment
Bubbles Rice,waterorsandinalargecontainer Spinningtoys Flashlight Shapesorters Pegpuzzles Squirting,SqueezingToysandplaydough Cushions Blankets Trampoline Tricycle Playdoughandcookiecutters Mirror
Some MotivatorsorSensory Toys
A“SensoryDiet”
Coinedbyan OT Patricia Wilbarger
Personalizedactivityplanthatprovidesthesensoryinputapersonneedstostayfocusedandorganizedthroughouttheday.
• toleratesensationsandsituationsthatarechallenging• regulateemotions,alertnessandincreaseattentionspan• reduceunwantedsensoryseekingandsensoryavoidingbehaviors• handletransitionswithlessstresshttps://
www.sensorysmarts.com/sensory -
c hecklist.pdf
ASampleSensoryDietof anineyearsoldASDKid
IntheMorning
•Massagefeet andbacktohelpwakeup•ListentorecommendedtherapeuticlisteningCD•Usevibratingtoothbrushand/orvibratinghairbrush•Eatcrunchycerealwithfruitandsomeprotein•SpinonDizzyDiscJr.asdirected•Jumponmini-trampolineasdirected
Afterschool
•Gotoplaygroundforatleast30minutes•Spinningondiscorswing•Mini-trampolinejumps•Gym ballexercises•Listentotherapeuticlisteningorfavouritemusicorsongs.
ASampleSensoryDietof anineyearsoldASDKid
Atdinnertime
• Helpset table,using twohandstocarryandbalance• Providecrunchyandchewyfoods
Atnight
• Warmbathwithbubblesandcalmingessentialoil• Listeningtomusic• Massageduringreadingtime
4.5Yearsold,Hope
•6:30 am–Wakeup•6:30–6:40–Playswithbeany bagtoys.•6:40 –7:00 –Getting Hopedressed andprovideherwith
• Lotion rub, massagewithvibrating massager orcircular motion on herarmsand legs.
• Whileeatingbreakfast,Hopewillbeencouragedtoputhernewweightedlappadonherlaporacrosshershoulders.
•7:00-7:30–Freeplaytimebeforeleavingforpreschool.Hopetendstogetintotrouble thistime ofdayasshegetsintoplaces she’snotsupposedto.•Tryheavyworktaskstohelpwithorganization.
• Pushweightedlaundrybasketaroundupstairsbedroomswhileparentsfinishgettingready
• Roll8lb ballaroundbedroom• Helpwaterindoorplantswithgallonjug
•7:30-8:00– transition to Preschool•8:00–8:15–Greetingtimeatpreschool.Hopestruggleskeepinghandstoselfandstayinghercarpetsquareduringfirstpartofherdayatpreschool.
• GiveHopeaheavyworkjobtocompleteimmediatelyeachmorning.
• Helpputbooks(heavytextbooks,notchildren'sbooks)awayontoshelvesaspartofhelpinggettheroomreadyfortheday
• Carryingabucketoftoysfromoneclasstoanother• Eras
echalkboard,encouraginghertousestrong,forcefulbackandforthmovements.
•8:15–9:00–RecessorGym.EncourageopportunitiesforHopetodothefollowing:• Swing onswingset• Hangonmonkeybars• Jumpingontrampoline
•9:00–9:15–Morningsnack• Expose Hopeto foodswithmultipletextures– thingstheother childrenareeating.• ProvideHop
ewithverychewy,crunchyfoodstohelpgivehergoodproprioceptiveinputintoherjaw.
• Granola• Chewybagel• Bighardpretzel
•9:15-10:00–Crafttime• HaveHopecompleteaheavywork/calmingtaskbeforesittingdown
• Chairpushup• Completingthe“job”theyshehasinthemorning• Rolling ontopof therapyball
• Weightedproduct• LetHopewearherlappadfromhome• Consideruseofweightedvestorcompressionvest
•10:00–10:30–Freeplay.Hopeusuallydoeswell atthistime.•10:30–10:45–Bathroombreak.Again,Hopetransitionswell
•10:45–11:15–Music,Art,orComputertime.Hopestrugglesstillatthesetimes
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